Abstract | BACKGROUND: METHODS: The authors performed focused analyses of the Multicenter Perioperative Outcomes Group (2005 through 2016), North American MH Registry (2013 through 2016), and Anesthesia Closed Claims Project (1970 through 2014) databases, as well as a systematic literature review (1987 through 2017). The authors used difficult mask ventilation (grades III and IV) as a surrogate for airway rescue. MH experts judged dantrolene treatment. For MH morbidity/mortality analyses, the authors included U.S. and Canadian cases that were fulminant or scored 20 or higher on the clinical grading scale and in which volatile anesthetics or succinylcholine were given. RESULTS: Among 6,368,356 queried outcomes cases, 246,904 (3.9%) received succinylcholine without volatile agents. Succinylcholine was used in 46% (n = 710) of grade IV mask ventilation cases (median dose, 100 mg, 1.2 mg/kg). Succinylcholine without volatile anesthetics triggered 24 MH cases, 13 requiring dantrolene. Among 310 anesthetic-triggered MH cases, morbidity was 20 to 37%. Treatment delay increased complications every 10 min, reaching 100% with a 50-min delay. Overall mortality was 1 to 10%; 15 U.S. patients died, including 4 after anesthetics in freestanding facilities. CONCLUSIONS:
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Authors | Marilyn Green Larach, Thomas T Klumpner, Barbara W Brandom, Michelle T Vaughn, Kumar G Belani, Andrew Herlich, Tae W Kim, Janine Limoncelli, Sheila Riazi, Erica L Sivak, John Capacchione, Darlene Mashman, Sachin Kheterpal, Fabian Kooij, Janet Wilczak, Roy Soto, Joshua Berris, Zachary Price, Steven Lins, Peter Coles, John M Harris, Kenneth C Cummings 3rd, Mitchell F Berman, Masakatsu Nanamori, Bruce T Adelman, Christopher Wedeven, John LaGorio, Patrick J McCormick, Simon Tom, Michael F Aziz, Traci Coffman, Terri A Ellis 2nd, Susan Molina, William Peterson, Sean C Mackey, Wilton A van Klei, Adit A Ginde, Daniel A Biggs, Mark D Neuman, Robert M Craft, Nathan L Pace, William C Paganelli, Marcel E Durieux, Bala J Nair, Jonathan P Wanderer, Scott A Miller, Daniel L Helsten, Zachary A Turnbull, Robert B Schonberger, Multicenter Perioperative Outcomes Group |
Journal | Anesthesiology
(Anesthesiology)
Vol. 130
Issue 1
Pg. 41-54
(01 2019)
ISSN: 1528-1175 [Electronic] United States |
PMID | 30550426
(Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't, Systematic Review)
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Chemical References |
- Muscle Relaxants, Central
- Neuromuscular Depolarizing Agents
- Dantrolene
- Succinylcholine
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Topics |
- Dantrolene
(therapeutic use)
- Databases, Factual
- Humans
- Malignant Hyperthermia
(drug therapy, etiology)
- Muscle Relaxants, Central
(therapeutic use)
- Neuromuscular Depolarizing Agents
(adverse effects)
- Succinylcholine
(adverse effects)
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